Public Health and a Healthy Public
We have the responsibility to choose what kind of human beings we will be.
Consider: public health. The public’s concern for health? The health of the public? Health in public? Publicly healthy? (Privately unhealthy?) The last year has given many Americans more than ample cause to wonder what exactly it is we mean to talk about when we talk about public health. It is the justification of the moment, after all. To the degree we remain a political order guided by deliberation, it should be no surprise that the term is inexact, with as many predicates and implications as users. As our supposed experts continue to heap shame and embarrassment upon themselves, I feel no qualms adding my own unqualified thoughts on the matter. What should we mean by public health?
Let’s start with health, which oddly seems the less-discussed and more ill-defined half of the phrase these days. Health describes the correct and full function of an organism, without injury or disease. We say a thing is healthy when it exhibits or contributes to this state of being. The blooming flower is healthy. So too is water to the thirsty, or insulin to the diabetic. Because we live, develop, and grow in a world of change, health is a kind of dynamism; the homeostasis of an organism is not a static condition but a robustness, vigor, and potency for responding to variable conditions. It is a tendency to baseline, not a line.
The state of health can be cultivated. In the human animal—as the being which is aware of itself rationally, and not only by instinct—this is done by us to us. Fitness in nature is a fittedness to a given environment; the fit maintain their homeostasis in the dynamics of a particular system, and thus their health, while the unfit do not. But because humanity lives in a world shaped by its own interventions, fitness is a power and process to shape the self to respond to the shaped environment. Fitness is choosing health, and since health is a right ordering of the dynamic organic system, at its most basic fitness is motion and the capacity for movement. The healthy baby wiggles, then crawls, then toddles, then falls, and finally walks and leaps.
You may think all this is straightforward enough, but apparently it’s not clear to everyone. “People who tended to be sedentary were far more likely to be hospitalized, and to die, from Covid than those who exercised regularly.” That baby-brain bit of obviousness comes courtesy of the New York Times, reporting on a new study of infection outcomes in California. Don’t blame the Times, though; it’s just doing its job as the mouthpiece of the establishment. Blame instead a medical and science culture of expert trusting that needs a study after the fact to confirm that, yes, indeed, “those who had been the most active before falling ill were the least likely to be hospitalized or die as a result of their illness.” Turns out the healthier get less sick.
How did that become a news story instead of common sense? Why wasn’t that advice shouted from rooftops last March? That brings us to the first half of public health, the public. Public in this sort of use is the “someone should do something about that” or “there ought to be a law” sentiment. It’s the acknowledgment that some things are everybody’s problem, obesity, for example. But public is also the recognition that we share an environment with our fellow citizens, and that our contributions to that environment affect them in a chain of human ecology. Economics, infrastructure, law, air, earth, and water, are all media by which this public connection comes into being.
Public health, then, is a declaration of responsibility: We, the public, are responsible for the health of us, the public. It’s an expansive responsibility. Each of us, as a part of that public, can support public health by pursuing fitness, by moving and making choices that make it easier to move. All of us, as part of that public, can recognize that there are ways to assist each other in choosing health through the public actions of government; we can reform regulation to incentivize the planting, growing, and eating of healthy food, or to stop subsidizing the causes of a sedentary and gluttonous life. Public health need not be another area of learned helplessness. Individually and collectively, a healthy public should be something we want all the time, not the rallying cry of an emergency.
The public ought to be the complement of the private, held in tension but not one swallowing up the other. In the emergency of the last year, measures taken in the name of public health have reduced the private sphere to that which is permitted by a totalizing public health regime. This is biopolitics as the philosopher Giorgio Agamben has warned of. What is given can be taken away, and we are made to operate under rules that have the social force of law but are not laws made by normal legislation, and so we are all placed outside the law. Lockdown measures were a kind of locating dislocation, fixing us in our homes, but stripping out those parts of life which are cultural and conventional and make us the particular human being that each of us is. Our civic life is life lived in public, face to face, in restaurants and on sidewalks and in schools and in gyms and parks and churches. In an attempt to manage the binary biological states of dead or alive, instead of encouraging and helping us to choose fitness and the healthy, our public health authorities have, over the last year, furthered the transformation of citizens into subjects.